KẾT QUẢ BÓC NHÂN PHÌ ĐẠI LÀNH TÍNH TUYẾN TIỀN LIỆT NỘI SOI QUA NIỆU ĐẠO BẰNG HOLMIUM-LASER TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

Abstract

1. Purpose: In this study, we apply the technique of enucleation modified en block of benign prostate hyperplasia by Holmium laser and evaluate the early results of this surgery. 2. Materials and Methods: We evaluated on 258 patients with urinary disorders due to benign prostatic hyperplasia, undergoing surgery to remove hypertrophic benign prostate by Holmium laser from January 2020 to January 2022. The en bloc method enucleation modified was performed by 2 incisions at 12 o'clock and 6 o'clock. Perioperative we assessed the time of enucleation, the time of morcellation to take the specimens out. The amount of blood lost during surgery, bleeding complications. Postoperative parameters include: time of urethral catheterization, length of hospital stay. Functional outcomes: Qmax and IPSS at 3 month postoperative. Short term complications including clot retention (blood clot retention in the bladder), blood transfusion, urinary tract infection, recatheterisation, and incontinence. Clavien–Dindo classification complications, and continence status were assessed. Patients were assessed for follow-up after surgery for 3 month. 3. Results: The average age of the study group is 74,51. The average weight of prostate is 77,54g (30-230g). The average PSA is 8,23ng / ml. The mean preoperative IPSS is 25,27. The average operation time is 72,55 minutes, of which the time of enucleation is 50,76 minutes and the time of morcellation is 18,55 minutes. The average blood lost during surgery is 7,26g/l. During surgery, there were 8 patients with severe bleeding requiring blood transfusion. The average time of urethral catheterization is 4.55 days, the average length of hospital stay is 5.31 days. After surgery, 18 patients (6,97%) had urinary retention to have their recatherization and 32 patients had stress incontinence when changing their posture (12,40%). After 3 months, 229 (88,75%) patients urinated normally. There were no serious complications after surgery. 29 patients still had stress urinary incontinence (11,24%). The average postoperative IPSS is 5,14 ± 3.7. The postoperative weight of prostate determined by ultrasound is 22.50 ± 2,5g. 4. Conclusion: The procedure of enucleation of benign prostatic hyperplasia by two incisions at 6 and 12 o'clock with Holmium laser is safe and effective surgery for all sizes of benign prostatic hyperplasia.